You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment III1 Apr 2015PD19-01 THE VALUE OF OPEN CONVERSION SIMULATIONS DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: IMPLICATIONS FOR ROBOTIC TRAINING CURRICULUMS Fabio Zattoni, Vidit Sharma, Andrea Guttilla, Alessandro Crestani, Francesco Cattaneo, Fabrizio Dal Moro, and Filiberto Zattoni Fabio ZattoniFabio Zattoni More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Andrea GuttillaAndrea Guttilla More articles by this author , Alessandro CrestaniAlessandro Crestani More articles by this author , Francesco CattaneoFrancesco Cattaneo More articles by this author , Fabrizio Dal MoroFabrizio Dal Moro More articles by this author , and Filiberto ZattoniFiliberto Zattoni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.700AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a dearth of protocols, formal guidance, and procedural training regarding open conversions from robot-assisted radical prostatectomy (RARP) to open radical prostatectomy (ORP). An open conversion (OC) places complex demands on the health care team and has recently been shown to be associated with adverse perioperative outcomes. Here we perform a root cause analysis of OC simulations to identify errors that may contribute to adverse events during open conversions. METHODS From May 2013 to December 2013 we prospectively simulated 20 emergencies during RARP requiring OC using a team of two surgeons, an anaesthesiologist and three nurses. All simulations were timed, transcribed, and filmed in order to identify errors and areas for improvement. Protocols were developed using both internal review within the simulation team and external feedback from third party observers. RESULTS The average conversion time was 130.9 ± 28,7 (90-201) seconds. Frequencies of the observed errors were as follows: incorrect sequence (70%), errors in robot replacement (50%), loss of sterility (40%), steric conflict (40%), communications (25%), lack of leadership (25%), and dropping instruments (25%). Three main strategies were implemented to reduce errors: improving leadership, clearly defining roles, and improving knowledge base. By the last simulation, conversions were performed without errors and using 55.2% less time compared to initial simulations. CONCLUSIONS In this preliminary study, simulations uncovered several problem areas during the process of open conversion from RARP to ORP. Repeated simulations, increased leadership, and improved role delineation enabled faster and less flawed conversions. Further study is necessary to identify if such protocols may translate to improved patient safety during actual open conversions. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e391 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabio Zattoni More articles by this author Vidit Sharma More articles by this author Andrea Guttilla More articles by this author Alessandro Crestani More articles by this author Francesco Cattaneo More articles by this author Fabrizio Dal Moro More articles by this author Filiberto Zattoni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...